Renal Hemodynamics After Lung Transplantation

Abstract

Renal function impairment is common after solid organ transplantation, due to the nephrotoxicity of cyclosporine. Moreover, in patients with severe respiratory failure, renal function is often impaired. This renal function impairment may predispose patients to further renal function impairment after lung transplantation. Therefore, renal hemodynamics were measured in 44 patients before lung transplantation and 1, 6, 12, 18, 24, and 30 months after transplantation. After transplantation, a decline in renal function occurred, with a progressive fall in glomerular filtration rate (GFR) of 33 +/- 4% at 12 months and 42 +/- 9% at 30 months. Effective renal blood flow fell by 22 +/- 5% at 12 months and remained stable thereafter. Changes in effective renal plasma flow (ERPF) were less pronounced than those of effective renal blood flow, due to a fall in hematocrit after transplantation. Blood pressure and renal vascular resistance increased significantly, consistent with the effects of cyclosporine. Prior to transplantation, renal function impairment with intense renal vasoconstriction had been found in a subset of the patients. Remarkably, the decrease in renal function after transplantation was less pronounced in patients with renal function impairment prior to transplantation, as indicated by significant negative correlations between pretransplantation GFR and the percentage change in GFR after transplantation, and pretransplantation ERPF and the percentage change in ERPF after transplantation. This suggests that the net course of renal hemodynamics after lung transplantation is the result of the opposed effects of cyclosporine nephrotoxicity and the favorable effects of the normalization of respiratory status. In conclusion, after lung transplantation a decline in renal function occurs that is less pronounced in patients with renal function impairment and intense renal vasoconstriction prior to transplantation. Such a renal function impairment, therefore, should not be considered a contraindication to lung transplantation.

Recovery from AKI and Short- and Long-Term Outcomes after Lung Transplantation

“…Additionally, of interest, despite the fact that patients with pulmonary hypertension were more likely to experience AKI, there was a trend for higher rate of recovery from such injury. In these patients generally, right-sided heart failure is present, and the resulting cardiorenal pathophysiology may impair renal perfusion and elicit a state of intense renal vasoconstriction (12). Thus, post-transplant, these patients may be simultaneously at higher risk of a hemodynamic-mediated temporary decline in GFR and more apt to recover function with eventual improvement in their circulatory status and renal perfusion, thus explaining return of their creatinine to, at least, their preoperative baseline.…”

Determinants of renal impairment in heart transplant recipients: The ischaemic cardiomyopathy group is more prone to adverse renal outcome

“…In the setting of a heart transplant recipient, there is a persistent inflammatory response due to rejection. The up-regulation of multiple cytokines, chemokines, and chemokine receptors within the first day after transplantation [18] along with the previously compromised renal function [2,19,20] further promotes renal impairment. In our study, prolonged CPB time proved to affect renal function.…”

Advanced pulmonary arterial hypertension: mechanical support and lung transplantation

“…Contraindications for lung transplantation may include failure of other organs, obesity, malignancy and a history of non-adherence to medical therapies [12,17]. An exception to these criteria is chronic renal impairment due to venous congestion, which should not be an absolute contraindication due to evidence which shows that this condition is reversible after lung transplantation [15].…”

“…In patients with end-stage PAH for whom all available treatment options have been exhausted, palliative care should be considered [35]. Current or a history of non-compliance to medical therapy Psychiatric or psychological conditions associated with inability to adhere to medical therapy Substance abuse or dependence Absence of an adequate or reliable social support system Severely limited functional status with poor rehabilitation potential # : unless combined organ transplantation can be performed, except in the case of chronic renal impairment due to venous congestion which is often reversible following lung transplantation [15].…”